Association between adherence to evidence-based guidelines for the prescription of non-steroidal anti-inflammatory drugs and the incidence of gastric mucosal lesions in Japanese patients.

Tsumura, Hidetaka; Fujita, Tsuyoshi; Tamura, Isamu; Morita, Yoshinori; Yoshida, Masaru; Toyonaga, Takashi; Mukai, Hidekazu; Inokuchi, Hideto; Kutsumi, Hiromu; Azuma, Takeshi

Objective: Recently, guidelines for the treatment and prevention of ulcers induced by non-steroidal anti-inflammatory drugs (NSAIDs) were established. This study investigated the association between the current adherence to the guidelines and the incidence of gastric mucosal lesions caused by NSAIDs. Methods: This study included 254 NSAIDs users (128 regular and 126 on-demand users) who had undergone upper gastrointestinal endoscopy. The patients were characterized as high risk based on the following: age 65 years or older, history of peptic ulcers, concurrent use of corticosteroids or anticoagulants, and high-dose NSAIDs use. Adherence was defined as the prescription of NSAIDs with proton pump inhibitors, prostaglandin analogues, or high-dose histamine 2 receptor antagonists in high-risk NSAIDs user. The severity of gastric mucosal lesions was evaluated using the modified LANZA score (MLS). Results: Seventy-nine (61.7%) of the regular NSAIDs users and 65 (51.6%) of the on-demand NSAIDs users met our definition of high-risk patients. Adherence in the regular NSAIDs users and on-demand NSAIDs users was 25 (31.7%) and 16 (24.6%), respectively. The incidence of gastric mucosal lesions (MLS ≧ 1) was significantly higher in the nonadherence group than in the adherence group for both regular NSAIDs users (59.3 vs. 28.0%, P = 0.01) and on-demand NSAIDs users (63.3 vs. 25.0%, P = 0.01). Gastric ulcers in the regular NSAIDs users were more frequently observed in the nonadherence group than in the adherence group (29.6 vs. 4.0%, P < 0.01). Conclusion: Nonadherence was associated with a high prevalence of NSAIDs-induced gastric mucosal lesions.

PATIENT compliance; NONSTEROIDAL anti-inflammatory agents; GASTRIC mucosa; EVIDENCE-based medicine; PEPTIC ulcer; JAPANESE people; DISEASES

Journal of Gastroenterology, 2010, Vol 45, Issue 9, p944

0944-1174

Academic Journal

10.1007/s00535-010-0236-2